Authors: Anne Mosebo med.stud., Mia Steffenssen MD and Magnus Balslev Avnstorp, MD.

Introduction

Generally, a biopsy should be performed on all non-healing lesions on the lip and lesions that in other ways show signs of malignancy. 

The location and size of the lesion play an important role when deciding on type of excision. Primary closure is possible if the tumor constitutes less than 30% of either the upper or lower lip. In this chapter we describe different surgical techniques which result in a direct closure. 

Types of lip excisions

Type of excision	Upper lip	Lower lip
W-excision		x
Pentagonal-wedge resection		x
V-excision	x	x
Shield excision	x	x
Rectangular excision	x	x
T-excision	x (near philtrum)

Re-establishment of the lip

It is important to re-approximat both the orbicularis muscle for functionality of the lip and the vermillion-cutaneous junction for the cosmetic result. 

Where the lower lip consists of only one anatomical subunit, the upper lip consists of three (philtrum and two lateral segments), which in general makes reconstruction of the upper lip more difficult. 

Contraindications 

Lip defects exceeding 30 mm of length

Lesions that significantly exceeds the vermillion-cutaneous junction

Lesions involving the oral commissary

Lesions with deep extension into the oral cavity or lip musculature